EDGAR BEDOLLA (NPI# 1265691158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265691158 |
| Entity Type | Individual |
| Full Name | EDGAR BEDOLLA |
| Credential | MD |
| Practice Address |
415 E Southlake Blvd Ste 202 Southlake TX 76092 |
| Mailing Address |
415 E Southlake Blvd Ste 202 Southlake TX 76092-6280 |
| Practice Telephone | 8174168080 |
| Mailing Telephone | 8174168080 |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2018-08-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 27188 | OK | Allopathic & Osteopathic Physicians |
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
R7662 | TX | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5824 W Plano Pkwy Ste 102, Plano, TX 750934697 | 8174168080 | |
| 8128 Park Ln Ste 130, Dallas, TX 752316049 | 8174168080 | |
| 920 Stanton L Young Blvd, Wp 2140, Oklahoma City, OK 731045036 | 2142716308 |
| Street Address |
415 E SOUTHLAKE BLVD STE 202 |
| City | SOUTHLAKE |
| State | TX |
| Zip Code | 76092 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376942987 | Virtuoso Surgery Center | Clinic/Center | 415 E Southlake Blvd Ste 202, Southlake, TX 76092-6280 | 2014-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730718990 | Elizabeth Beazley | Family Medicine | 1050 E. Hwy 114 Suite 100, Southlake, TX 76092 | 2020-04-08 |
| 1518508894 | Arbor Pediatrics, Pllc | Pediatrics | 1130 N Kimball Ave, Southlake, TX 76092 | 2019-10-08 |
| 1346882685 | Gs Ortho Assists, Pllc | Physician Assistant | 2600 East Southlake Boulevard Suite 120, Southlake, TX 76092 | 2019-10-08 |
| 1609340496 | Rebecca Leigh Lander | Physician Assistant | 1170 N Carroll Ave., Southlake, TX 76092 | 2019-01-15 |
| 1225506223 | Physicians Wellness Associates Pllc | Family Medicine | 1920 East State Highway 114, Southlake, TX 76092 | 2018-11-07 |
| 1740762459 | Brandi L. Barker | Chiropractor | 590 N. Kimball Ave, Suite 140, Southlake, TX 76092 | 2018-08-30 |
| 1033699228 | Julie A. Seeber | Physical Therapy Assistant | 170 Stonebridge Lane, Southlake, TX 76092 | 2018-08-16 |
| 1992281364 | Alayna Powers | Nurse Practitioner | 900 E Southlake Blvd Ste 300, Southlake, TX 76092 | 2018-07-18 |
| 1346732153 | Amrittej Singh Virk | Dentist | 630 N Kimball Ave Ste 110, Southlake, TX 76092 | 2018-06-06 |
| 1740779594 | Radiant Family Dental Pllc | Dentist | 2012 Southlake Glen Dr., Southlake, TX 76092 | 2018-05-08 |
| Find all providers in zip 76092 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801408588 | Hill Country Plastic Surgery, Pllc | Surgery | 8042 Wurzbach Rd Ste 120, San Antonio, TX 78229-3818 | 2020-08-23 |
| 1154948198 | Walker Plastic Surgery Pllc | Surgery | 12590 Dallas Pkwy, Ste 200, Frisco, TX 75034 | 2020-06-25 |
| 1780242123 | Hands of Houston Pllc | Surgery | 6704 Ferris, Bellaire, Texas, TX 77401 | 2019-05-31 |
| 1609361419 | Texas Surgery Specialist, Pllc | Surgery | 1000 N Davis Dr Ste E, Arlington, TX 76012-3202 | 2018-06-25 |
| 1720575954 | Wijay Tops, Pllc | Surgery | 4306 Yoakum Blvd Ste 520, Houston, TX 77006-5883 | 2018-04-13 |
| 1437664067 | Austin Cosmetic Surgery | Surgery | 3102 Rr 620 S, Lakeway, TX 78734 | 2017-12-05 |
| 1326558594 | West Houston Aesthetic and Plastic Surgery Pllc | Surgery | 1717 Wisteria Way, Westlake, TX 76262-9083 | 2017-10-02 |
| 1235667189 | Lyos Plastic Surgery & Associates | Surgery | 9230 Katy Fwy Ste 420, Houston, TX 77055-7468 | 2017-05-23 |
| 1275071292 | Elite Breast & Trauma Care | Surgery | 7400 Fannin St # 700c, Houston, TX 77054-1920 | 2017-02-09 |
| 1699179390 | Sam T. Hamra M.d. P. A. | Surgery | 4131 N Central Expy # 950, Dallas, TX 75204-2102 | 2014-10-09 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EDGAR BEDOLLA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.